Inflammatory Bowel Disease

A 15-year -old adolescent male presented with insidious onset, low -grade fever on and off for 1 month, with fatigue and intermittent abdominal pain. His appetite and activity had decreased, and there was also loss of weight. Three weeks ago, he had crampy abdominal pain with semisolid stools mixed with blood 3–4 times daily. He was treated sequentially with oral cefixime and metronidazole. The loose stools subsided within a week, but intermittent abdominal pain and fever persisted. There was no history of contact with tuberculosis, any similar problem, or recurrent infections in the past. There was no history of any skin lesions or joint involvement. On examination, there was a low-grade fever with pallor and mild pedal edema. He had moderate thinness. There was no significant lymphadenopathy. Head to foot examination was normal. Abdominal examination revealed mild diffuse tenderness, and there was no free fluid. Anal and perianal regions were normal. Laboratory investigations revealed anemia, normal white blood cell counts, slightly higher platelet count, and raised erythrocyte sedimentation rate. Blood and urine culture showed no growth. Fresh stool examination repeated twice revealed WBCs and a few RBCs and there were no parasites. Serum albumin was 2.8 g/dL. The Mantoux test and chest X-ray results were normal. HIV status was negative. Inflammatory bowel disease (IBD) was suspected in view of prolonged fever, fatigue, loss of weight, and gastrointestinal (GI) symptoms. Colonoscopy revealed erythema with multiple aphthous ulcers throughout colon –pancolitis. Magnetic resonance enterography was done which revealed mural thickening of the entire large intestine and mild mural enhancement of the jejunum. Biopsy from colon showed non-caseating granuloma. A diagnosis of Crohn’s disease was made. The child was started on steroids and mesalamine along with nutritional support. Steroids were stopped after 12 weeks, and the child was continued on azathioprine maintenance . He has responded well with reduction of GI symptoms and weight gain. He is on regular follow-up.